Senior Disability Claims Specialist

Sedgwick; Orlando (FL); On-site; USD 65,000 - 95,000; Full time

Job summary

Sedgwick in Orlando is seeking an experienced disability claims professional to evaluate complex cases, review medical documentation, and determine benefits. You will coordinate investigations, collaborate with clinicians, and negotiate return-to-work arrangements while upholding service standards.

The role requires strong knowledge of ERISA and FMLA, plus familiarity with disability duration management. This position emphasizes client communication and teamwork in a dynamic environment.

Qualifications

• Three years of benefits or disability case/claims management experience or equivalent.
• Bachelor's degree preferred; state certification or licensing in statutory leaves may be required.
• Knowledge of ERISA regulations, disability duration and medical management.

Responsibilities

• Makes independent claim determinations to approve or deny complex disability claims.
• Reviews complex medical information to determine disability status per plan.
• Oversees complex claims including comorbidities and ADA accommodations.
• Utilizes clinical resources and coordinates referrals to outside vendors.
• Negotiates return to work with or without job accommodations.
• Maintains professional client relationships and ensures quality service.

Skills

ERISA regulations

FMLA regulations

Medical terminology

Written communication

Microsoft Office

Negotiation

Education

Bachelor's degree

Tools

Claims software

Job description

Sedgwick in Orlando is seeking an experienced disability claims professional to evaluate complex cases, review medical documentation, and determine benefits. You will coordinate investigations, collaborate with clinicians, and negotiate return-to-work arrangements while upholding service standards.

The role requires strong knowledge of ERISA and FMLA, plus familiarity with disability duration management. This position emphasizes client communication and teamwork in a dynamic environment.